For the full article, please visit chapter 17b from the lifestlye guide menu, or visit this link.

We’d love to read your comments on the article, so please feel free to leave your thoughts on what we’ve written about combating leakage via the comments form, or Facebook comments box at the bottom of the Combat Leakage page. Dont foget to “like” the page if you, um, like it.

I’d also like to take this opportunity to wish you all a very happy new year, and a happy and prosperous 2012.

Useful Links:
Ostomyland Editoral #2: Combat Leakage – Some Products You May Not Be Aware Of
http://ostomyland.com/mainsite/combating-leakage-some-products-you-may-not-be-aware-of/
Ostomyland Lifestyle Guide: Chapter 17 – Leakage / Skin Problems
http://ostomyland.com/mainsite/chapter-17-leakage-and-other-skin-problems/

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Named the Anterior Perineal Plane for ultra-low Anterior Resection (APPEAR for short – wheres the “e” come from?), the operation involves removing the diseased part of the bowel and surgically altering part of the remaining bowel to form a pouch to recreate the rectum.

Pioneered by Professor Norman Williams of Barts hospital, London, the operation takes five to six hours to perform. However the operation is not suitable for those with advanced bowel cancer, or severely damaged sphincter muscles, but for those who did have the operation as part of a multi-centre trial performed around the world, two thirds of the patients reported a success with normal function resuming within six months, and for some it was as little as two months.

You can find the article on the Daily Mail website. And for more information visit Bowel Cancer Research Organisation website, or if in the UK phone them on: 020 7882 8749.

Useful Links:
Source Article about APPEAR on the Daily Mail website:
http://www.dailymail.co.uk/health/article-2070375/New-bowel-operation-replace-colostomies.html
Bowel Cancer Research Organisation (UK):
http://www.bowelcancerresearch.org/

Update: 08 December 2011 – 10am.

This story has certainly caused a stir amongst our readers both here on the Oland community and on our Facebook group, and various other ostomy websites around the world too.

One question was raised which was not answered by the article: Whats the difference between the APPEAR procedure, and the current J-Pouch procedure. Now, Im no medical student, and I have no personal experience of the J Pouch other than being in the same hospital ward bay as people having it, or having ileostomies as a result of a pouch failure. So, I decided to do a search via the various medical research database sites to try and find the answer, and to be honest, very little freely available information is available. Theres only a couple of articles registered about the trial so far, and it costs over $50 to buy a copy, so all we have to go on is the various extracts.

Here are some quotes and links to the extracts I found, including links to where you can buy the article if you are interested in it yourself. From what I’ve read it seems that the operation would still be available even if you didnt qualify for a JPouch normally. So it gives more options for people I guess. If you do buy the article, and you find out what the differences are between the APPEAR procedure and a JPouch please do write in and let me know! You can email me here. The article extracts and page links are available below. (Click on Continue Reading… if it appears)

More Links and Quotes:
Bowelcancerresearch.org – Innovative Op Makes The News
http://www.bowelcancerresearch.org/news/index.php?article=33
This is a more indepth article focusing solely on the personal story of APPEAR patient, Louisa Smalley, whom was featured in the original Daily Mail article we featured yesterday

ClinicalTrials.gov - Anterior Perineal Plane for Ultra Low Anterior Resection of the Rectum (APPEAR)
http://clinicaltrials.gov/ct2/show/NCT00534131?term=18438111+%5BPUBMED-IDS%5D&rank=1
This is the full trial application in the USA, detailing the three specific arms of the trial, along with its purpose and eligibility criteria. According to ClinicalTrials.gov the trial is still active and recruiting patients.

Pubmed.gov - Anterior Perineal PlanE for Ultra-low Anterior Resection of the Rectum (the APPEAR technique): a prospective clinical trial of a new procedure.
http://www.ncbi.nlm.nih.gov/pubmed/18438111?dopt=Abstract
This is the most commonly appearing article on Google, and it is available to buy to read at the link below (Annals of Surgery). However, here is the freely available extract summary of the  article.

OBJECTIVE:

The APPEAR procedure was developed to allow sphincter-preserving rectal resection for both benign and malignant pathology, which would traditionally require abdominoperineal excision or completion proctectomy, if treated by conventional means. This clinical trial (clinicaltrials.gov: NCT00534131) evaluated the short-term clinical and physiological results of this procedure.

METHODS:

Fourteen patients were enrolled, 7 with neoplasia, 5 with ulcerative colitis, and 2 with traumatic rectal damage. Patients were evaluated preoperatively, and at a median of 2 years after surgery.

RESULTS:

Nine of 14 patients underwent ileostomy reversal and were followed up for a minimum of 1 year, with 1 patient awaiting closure. Four patients have not yet been considered for ileostomy reversal due to anastomotic perineal fistulae. Transient sexual dysfunction was noted in 3 of 14 patients, but no urological problems occurred. When the APPEAR procedure was performed for neoplasia or trauma, postoperative median Wexner continence score was 5 (range 0-8, n = 6), with a median defecation frequency of 3 (range 1-8/day). All cancers were completely excised with no local recurrence. Following APPEAR with restorative proctocolectomy for ulcerative colitis, median Wexner continence score was 2 (range 0-6, n = 3), with a median daily defecatory frequency of 3 (range 1-5). Preoperative SF-36 scores did not change significantly following ileostomy closure, and anorectal physiological testing was unaltered following perineal dissection.

CONCLUSIONS:

The APPEAR procedure provides an alternative technique to effect an ultra-low sphincter-saving anastomosis, when this is not possible by conventional surgery. Morbidity was encountered and greater experience will be required to fully assess this approach. Nevertheless, this is a promising new procedure with the potential to reduce the need for a permanent stoma even further than is currently the case.

Annuls of Surgery – Purchase the journal article “Anterior Perineal PlanE for Ultra-low Anterior Resection of the Rectum (The APPEAR Technique): A Prospective Clinical Trial of a New Procedure”
http://journals.lww.com/annalsofsurgery/pages/articleviewer.aspx?year=2008&issue=05000&article=00006&type=abstract
This is the medical journal website which you can purchase the article from. However, other websites will offer it to buy, and you can find them by searching the full title as shown above.

Pubmed - Anterior Perineal PlanE for Ultralow Anterior Resection of the Rectum (the APPEAR Technique): a video demonstration.
http://www.ncbi.nlm.nih.gov/pubmed/20039211
Finally, there is also a video demonstration of the operation available on the medical journal database websites, however it appears (no pun intended) that this is not free either, as I’ve not been able to find the video to play, but there is a text extract which describes the APPEAR procedure in a bit more detail. The extract reads:

Background:
Sphincter-saving rectal resections have become commonplace in the surgical treatment of malignant rectal pathology. However, restoration of gastrointestinal continuity by means of conventional techniques proves technically challenging in cases of very low rectal pathology, with resultant variable requirements for a permanent stoma. The APPEAR procedure (Anterior Perineal PlanE for Ultralow Anterior Resection of the rectum) is a novel sphincter-saving resection technique to restore gastrointestinal continuity in those who would otherwise require a permanent stoma with conventional abdominal resections. It ensures that the distal rectum is excised and the anastomosis is constructed under direct vision while simultaneously preserving the anal sphincter and its somatic nerve supply in their entirety.

Indications:
This procedure is indicated in the following instances: proven lower-third rectal carcinomas where anatomical restrictions prevent satisfactory rectal dissection and/or transection with a potential inadequate distal clearance margin; ileoanal pouch formation for ulcerative colitis or familial adenomatous polyposis where retained rectal tissue is at risk of future malignancy; short or strictured rectal stumps where pelvic dissection is hazardous and thus prevents restoration of gastrointestinal continuity.

Conclusions:
The APPEAR technique is a feasible alternative sphincter-saving procedure to further reduce the requirement of permanent stoma in the treatment for ultralow rectal pathology; however, it is appreciated that a larger study group with long-term follow-up is required. This technique should facilitate laparoscopic rectal resection because large and distal tumors can be dissected and excised through the perineal wound, ensuring adequate distal clearance and the anastomosis constructed under vision at an appropriate level. Furthermore, the requirement for an abdominal incision is avoided, improving cosmesis.

After a big google I’ve also managed to dig up a 2 page PDF document of the text for this “Video Demonstration”, which goes into detail of how the operation is performed, along with indications, procedure and phases. You can download this document here, from the link below:

Download – the accompanying text article for Anterior Perineal PlanE for Ultralow Anterior Resection of the Rectum (the APPEAR Technique): a video demonstration:
http://www.ostomyland.com/downloads/APPEAR-videodemo-fulltext.pdf
To Open Now: Click the link
To Save the File: RIght Click the link and choose Save As…

Should we find out any new information on the APPEAR procedure we will ofcourse let you know, as we’ll be keeping a close eye on this new operation.

  This content has been Digiproved © 2011 Ostomyland

Professor Joy Notter, from Birmingham City University says the following in the survey’s welcome letter:

The survey has been designed to find out what impact a colostomy has [...on the patient's...] life. The aim is to collect information that can form the basis of research to help specialist nurses and other healthcare professionals provide the best possible support and care for both new patients and those who have had a stoma for a long time.

Personally, I think that this survey is an excellent opportunity. I’m hoping that it will help lay to rest some of the over-exaggerated effects of a colostomy are, and that for most people having a stoma does not negatively impact on their life in any considerable way. Yes, we all have teething problems at the start, but overall I think it’s fair to say that today’s colostomates have never had it better thanks to the scientific advancements in surgery, appliances (pouches etc) and in the personal care we patients receive as a direct result of surveys such as this one here.

You may not agree with me (but I hope you do), and we may find the results show something totally different, but either way I hope you’ll consider completing the survey. It’s an excellent opportunity for colostomates to have their voices heard; to say where things are great, and where things could do with more work. And that can only be a good thing.

  This content has been Digiproved © 2011 Ostomyland

Published in: enteric – The Function Healthcare Technology Co-operative News, Autumn 2010

  This content has been Digiproved © 2011 Ostomyland

From the WCET website:
“The WCET provides an international forum for Enterostomal Therapy Nurses and a global vehicle for discussion, communication, research, advice and support in the field of Enterostomal Therapy Nursing. The WCET is focused on leading the global advancement of specialised professional nursing care for people with ostomy, wound or continence needs.”

For more information on the upcoming conference, and the WCET itself, please visit their website.

Useful Links:
WCET Website: http://www.wcetn.org/

  This content has been Digiproved © 2011 Ostomyland

The recommended dose is a quarter of the strength of those used to treat headaches. Professor Peter Elwood (an epidemiologist from Cardiff University, who carried out some of the first studies into the effects of aspirin on health) said taking aspirin at night and with calcium seemed to enhance its effects. He suggested taking it with a glass of milk as this could also reduce stomach irritation.

Aspirin is associated with an increased risk of bleeding, especially from the digestive track, and can aggravate certain medical conditions such as IBD. Patients with Crohn’s Disease, for example, and usually advised not to take it.

The study indicates that by taking aspirin for between four and eight years the protective effect continued for 20 years in both men and women.

The study does not suggest that we should all start taking aspirin. For each of us, our risk of developing cancer should be balanced against the risk of taking aspirin. And they advise that we discuss it with our GP. One important factor (in my opinion) is to ask about any possible drug interaction between aspirin and other medications we may be on.

The study is in The Lancet and  also in many of today’s papers. One link to it is here:
Small daily aspirin dose ‘cuts cancer risk’

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“I’ve written an ebook about my experiences dealing with the Disease and surgery etc, which I really hope is inspirational to others in a similar position” says Julie. “My book is for sale from my website and a £1 from the sale of each book goes to IBD research.”

For more information, and to buy a copy of Julie’s E-Book please visit: crohnsdiseaseandbeyond.co.uk

  This content has been Digiproved © 2010 Ostomyland

A 21 year old student from Devonhas been one of the first to undergo the procedure.

For the full story please visit the following page on the Daily Mail (UK) website:

http://www.dailymail.co.uk/health/article-1276821/Me-operation-Stem-cells-bones-healed-gut.html#ixzz0nicQV2FK

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The study that the BBC is reporting about was published in medical journal The Lancet which also suggests that these tests should be rolled out across the UK.

For the full report please check out Clare Murphy’s report on the BBC News website.
http://news.bbc.co.uk/1/hi/health/8647103.stm

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The operation was carried out by Professor Norman Williams at the Royal London Hospital. The surgeon also used muscle that was cut from above the man’s knee and then pulled back to his groin

It’s a fascinating article, and goes to show that in the future it might just be possible to reverse the so called “permanent” colostomy. This certainly takes us one step closer to that dream!

The article was printed in todays Sun newspaper, and you can click on the link below to read the full article over on the Sun website.

Read more: http://bit.ly/sunbionicbottom